2012 accountability hearing with the General Medical Council - Health Committee Contents


Conclusions and recommendations


The Law Commission's consultation on regulation of healthcare professionals

1.  We welcome the Law Commission's proposal that the Health Committee should play a role in the accountability process for professional regulation in the health and care sector. We stand ready to work with the Law Commission to prepare workable proposals which make this accountability effective. (Paragraph 14)

Progress on revalidation

2.  We welcome the fact that the system of medical revalidation is at last ready to be implemented. The purpose of the system should be to give the public greater assurance that the medical professionals treating them are being consistently and regularly appraised for their competence and fitness to practice. Although commencement of revalidation is a welcome first step towards providing this assurance, it is essential to recognise that its benefits will only be realised if the system is effectively managed and rigorously monitored. (Paragraph 20)

3.  We welcome the approach which the GMC is taking to ensure that all organisations responsible for doctors are engaged in the revalidation process from the outset, and that the doctors identified for revalidation are representative of the doctors across each organisation. We recommend that the practical implementation of this approach is monitored to ensure that candidates presented for revalidation are in fact properly representative. (Paragraph 27)

4.  Revalidation is a process which is designed to encourage continuing evaluation of a doctor's practice at the local level. We support the General Medical Council's message that all doctors should be considering now the steps which revalidation will require them to take in relation to their practice, irrespective of the date on which their revalidation recommendation falls due. (Paragraph 28)

Revalidation of doctors

5.  The introduction of employer liaison advisers to support responsible officers in assessing concerns around a doctor's practice is welcome. We expect this initiative to support earlier and more robust action in identifying such concerns and ensuring that they are appropriately dealt with. (Paragraph 33)

Remediation

6.  Although we recognise the danger of focussing on form rather than substance, we believe that it is an essential element of good practice for all organisations which employ doctors to have clear and effective procedures for reskilling, rehabilitation and remediation of medical staff when that is necessary. We expect the GMC to ensure that this condition is satisfied as part of its continuing programme for the development of revalidation and we shall seek assurances about the progress made in this area at our accountability session with the GMC next year. (Paragraph 43)

Consistency in revalidation

7.  Our previous reports have underlined the importance we attach to the role of the GMC as the "owner" and "leader" of the revalidation process. As revalidation is implemented, we look to the GMC to maintain this leadership role. This will involve actively monitoring and upgrading the operation of the new system to ensure that it fulfils its objective of providing greater assurance to patients about the quality and professionalism of doctors who provide care. (Paragraph 52)

Language competence of licensed doctors

8.  We consider that the proposed legislative changes to require responsible officers to assure themselves of the language competence of the doctors for whom they are responsible should be made as soon as possible, pending satisfactory amendment of the European Professional Qualifications Directive. In any event, we expect that should any issue about a doctor's language skills be identified, the responsible officer should be alerted immediately and should take appropriate action at once. The GMC and the Government should both confirm that this is their intention. (Paragraph 55)

9.  We are disappointed that no substantive progress seems to have been made at European level in addressing the underlying issue of language testing of doctors with primary qualifications from elsewhere in the EEA and in Switzerland. We continue to look to the Government, the GMC and the relevant EU institutions to produce a long-term solution to this problem within a timescale which reflects the potential risks to patients across Europe which are inherent in the present unsatisfactory situation. We ask the Government to set out in its response to this report the steps it is taking to seek amendment of the relevant Directive and the expected timetable. (Paragraph 57)

Revalidation and patients

10.  We continue to believe that the arrangements for informing patients of circumstances where a doctor has been required to undertake remediation measures are not sufficiently clear. In view of the imminent implementation of the revalidation process we recommend that the GMC take steps to clarify these procedures as a matter of urgency, and certainly before our accountability session next year. (Paragraph 63)

11.  We consider that the requirement to seek feedback from patients at least once every five years does not sufficiently reflect the aspiration of the GMC, which we share, to ensure that every doctor seeks periodic feedback from patients. The GMC should consider setting a more challenging target which will provide greater assurance to patients that their views are regularly sought and reflected upon by their doctors. (Paragraph 67)

GMC leadership activity in 2011-12

12.  We welcome and applaud the steps which the GMC has taken and continues to take to develop a broader understanding of professional obligation among doctors. We regard this ongoing process as the indispensable foundation of high quality care and we applaud the steps being taken by the GMC to encourage and support doctors to raise concerns when high professional standards are not met. We look to other regulators, and to health and care managers in both the public and private sector, to foster a culture in all health and care organisations where it is unacceptable not to raise such concerns when they arise. (Paragraph 73)

13.  The Chair of the GMC has written to all doctors to remind them that in the new world of commissioning, their decisions must not be influenced by a conflict of interest, and that patients come first. This unambiguous statement is commendable. We look to the GMC to take action on any evidence of conflicts of interest that have the potential to affect patient care adversely. (Paragraph 75)

14.  We consider that the GMC is uniquely placed to exercise a leadership function in the medical profession, and the healthcare professions more generally, and we applaud its willingness to do so. We encourage the Council to continue its leadership activities in concert with professional representative organisations. (Paragraph 79)

Trends in complaints against doctors

15.  We welcome the intention of the GMC to commission further research to understand the sustained upwards trend in complaints against doctors. The GMC should seek to learn lessons from this research to inform its regulatory practice. We look forward to discussing the outcomes of such research at the next accountability hearing. (Paragraph 84)

Proposals for procedural change

16.  We note the proposal to pilot arrangements where a doctor may accept a sanction in a 'clear-cut' case without requiring a panel hearing. We recommend that the GMC evaluate such pilots carefully to ensure that there is no detriment to the public interest in not holding a hearing, and publish detailed and clear guidance on the circumstances in which such a procedure may be considered appropriate. (Paragraph 88)

Completion of fitness to practise cases

17.  We continue to believe that the present fifteen-month target set for the GMC to conclude 90 per cent of its cases is insufficiently challenging; we invite the GMC to report to us in 2013 on the proportion of cases concluded within 12 months in 2012. (Paragraph 90)

18.  We are encouraged by the establishment of a functionally independent Medical Practitioner Tribunal Service, which we believe will provide greater assurance to the public about the quality of decisions made by the regulator about the fitness to practise of doctors. (Paragraph 94)

19.  The emphasis placed by the Chair of the MPTS on the consistency of its decision making, the effective management of its cases and the dissemination of best practice throughout the service is welcome. We look forward to examining the progress of the MPTS in 2013. (Paragraph 95)

Right of appeal against MPTS decisions

20.  We welcome the commitment of the Government to propose legislation to enable the GMC to appeal against decisions made by the Medical Practitioner Tribunal Service. We ask the Government to make clear when it intends to introduce legislation to fulfil this commitment. (Paragraph 96)


 
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Prepared 3 December 2012